Temporary Continuation of Coverage (TCC)

1 Office of Personnel Management Temporary Continuation of Coverage (TCC). under the Federal Employees Health Benefits Program (FEHBP). This pamphlet describes the conditions you must meet to be eligible for Temporary Continuation of Coverage (TCC) under the Federal Employees Health Benefits Program (FEHBP) when your regular Coverage ends. It also explains how to enroll in TCC, how much it costs, and how long it can continue. RI 79-27 Revised May 2014. Previous editions are not usable. Additional retirement and insurance information is available on the Internet. OPM Website Retirement information: Insurance information: Table of Contents What is Temporary Continuation of Coverage (TCC)? .. 1. How much does TCC cost? .. 1. Who is eligible for TCC? .. 1. What is a qualifying event? .. 1. Who is covered under a TCC self and family enrollment? .. 2. How long can Coverage continue under TCC? .. 3. How to obtain TCC if you separate from Federal service.

2 3. How to obtain TCC for children who lose FEHB Coverage .. 4. How to obtain TCC for former spouses .. 5. What are the spouse equity provisions of the FEHB law? .. 6. Enrollment options under TCC .. 8. Effective date of Coverage .. 8. Premium payments.. 9. Opportunities to change enrollment .. 9. Changing from a spouse equity enrollment to a TCC enrollment .. 10. Termination of enrollment or Coverage .. 11. Thirty-one-day Temporary extension of Coverage and conversion to an individual contract .. 12. Additional Information .. 13. i What is Temporary Continuation of Coverage (TCC)? TCC is a feature of the Federal Employees Health Benefits (FEHB) Program that allows certain people to temporarily continue their FEHB Coverage after regular Coverage ends. Important: You must exhaust TCC eligibility as one condition for guaranteed access to individual health Coverage under the Health Insurance Portability and Accountability Act of 1996.

3 If you have not exhausted TCC, you may purchase individual health insurance Coverage through a Health Insurance Marketplace during the annual open enrollment period or special enrollment period. How much does TCC cost? TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium) plus a 2. percent administrative charge. Who is eligible for TCC? Federal employees and family members who lose their FEHB Coverage because of a qualifying event may be eligible for TCC. What is a qualifying event? For employees, the only qualifying event is separation from Federal service. However, you are not entitled to TCC if you are involuntarily separated due to gross misconduct. Your human resources office decides whether conduct that leads to an involuntary separation is gross misconduct. If your human resources office decides that you were separated because of gross misconduct, it must notify you of that fact and explain what you can do to appeal the decision.

4 1. For children, the qualifying events are: reaching age 26, loss of status as stepchild, foster child, or recognized natural child, in the case of children whose Coverage has continued beyond age 26 because of their inability to support themselves due to a disability occurring before they reached age 26, recovering from the disability or becoming self-supporting, death of the employee or annuitant if the child does not qualify for a survivor annuity, and survivor annuity stops for any reason, including because he or she is no longer a full-time student. Spouses are not eligible for TCC in their own right, even if you separate from Federal service and decide not to elect TCC or you die. However, if your marriage ends other than by death, your former spouse is eligible for TCC. The qualifying events are: divorce, or annulment of the marriage. Who is covered under a TCC self and family enrollment? For a former employee, a TCC self and family enrollment covers the same family members as were covered under the regular self and family enrollment.

5 Family members must continue to meet the same eligibility requirements as under a regular self and family enrollment. A new family member, such as a new spouse or a newborn child, who is added during the TCC. enrollment period is also covered as a family member. 2. For a child with a TCC self and family enrollment, his or her spouse and children are covered family members. For former spouses, family members are limited to children of both the Federal employee and the former spouse. The new husband or wife of a remarried former spouse is not covered as a family member. How long can Coverage continue under TCC? Separating employees and their eligible family members can continue Coverage under TCC for up to 18 months after the date of separation from federal service. Children and former spouses who lose Coverage as a family member under an employee's or annuitant's regular FEHB. enrollment can continue Coverage under TCC. for up to 36 months after the date of the qualifying event.

6 Children and former spouses who lose Coverage as a family member under a former employee's TCC enrollment can continue Coverage under TCC for up to 36 months after the date of the employee's separation from Federal service. How to obtain TCC if you separate from Federal service If you lose your FEHB Coverage because you leave your Federal job, you are eligible for TCC. unless your separation is involuntary due to gross misconduct. Otherwise, the reasons for your separation don't matter. Your human resources office must notify you within 61 days after your regular FEHB. enrollment terminates of your opportunity to enroll under TCC. Generally, you have 60 days 3. after getting the notice or 60 days after separation, whichever is later, to enroll under TCC. It's a good idea to ask your agency to give you your TCC information on the day you separate. TCC enrollments and premiums always begin on the 32nd day after your regular Coverage ends (which happens on the last day of the pay period in which you separate).

7 The earlier you submit your enrollment form, the earlier your agency can process it, and the less likely it will be for you to receive a large bill for retroactive TCC Coverage . However, if you retire and you are eligible to continue your regular FEHB Coverage as a retiree, you aren't eligible for TCC because your regular FEHB Coverage doesn't stop. If you are retiring and you aren't sure whether you are eligible to continue regular FEHB Coverage as a retiree, ask your employing office. How to obtain TCC for children who lose FEHB Coverage If your child wants TCC, you must notify your employing office within 60 days after the qualifying event that caused your child to lose Coverage and supply the child's mailing address. Since the enrollment will be in the child's name, the child must complete the election form and the child will be billed for the Coverage . Within 14 days after it receives the information about the child, the employing office must notify the child of his or her TCC rights.

8 The child must make his or her election within 60 days after the later of: 4. the date of the qualifying event, or the date the child receives the notice about TCC rights from your employing office, if you notified the employing office within 60 days after the qualifying event. If you don't notify your employing office within the 60-day time limit, the opportunity to elect TCC ends 60 days after the qualifying event. If someone other than you (the employee). notifies the employing office about your child's eligibility, your employing office will notify your child of his or her TCC rights, but your child's 60-day time limit to elect TCC begins with the qualifying event, not the date of the employing office's notice of TCC rights. How to obtain TCC for former spouses If your former spouse doesn't meet all the requirements for enrollment under the spouse equity provisions of law (see page 6), he or she may be eligible for TCC. To be eligible for TCC, your former spouse must have been covered under your FEHB family enrollment at some time during the 18 months before your marriage ended.

9 (The term former spouse does not include widows or widowers.). If your former spouse wants TCC, you and your former spouse share the responsibility for notifying your employing office within 60 days after the qualifying event (divorce or annulment) and supplying the former spouse's mailing address. Within 14 days after your employing office receives the notice from you or your former spouse, it must notify your former spouse of his or her TCC rights. Your former spouse must elect TCC within 60 days after the later of: 5. the date of the divorce or annulment; or the date he or she receives the notice of TCC. rights from your employing office, if you or the former spouse notified the agency within the 60-day time limit given above. If you or your former spouse do not notify your employing office within the 60-day time limit, the opportunity to elect TCC ends 60 days after the divorce or annulment. If someone other than you or your former spouse notifies your employing office about your former spouse's eligibility, the employing office will notify your former spouse of his or her TCC rights, but your former spouse must elect TCC within 60 days after the divorce or annulment, not 60 days after the employing office's notice.

10 What are the spouse equity provisions of the FEHB law? The spouse equity provisions of law allow the former spouse of a Federal employee or annuitant to enroll in FEHB if he or she: Was covered under FEHB as a family member at some time during the 18 months before the marriage ended, Has not remarried before reaching age 55, and Has a qualifying court order (a court order that awards the former spouse a portion of the employee's or retiree's annuity benefit or a survivor benefit based on the employee's or retiree's Federal service). 6. The cost of Coverage under the spouse equity provisions is slightly less than under TCC. Spouse equity enrollees pay the full premiums (both the employee and Government shares), but they do not pay the extra 2 percent administrative charge. Coverage under a spouse equity enrollment does not begin until after the Office of Personnel Management has reviewed the court order to determine if it is qualifying and the employing office receives both the election form and proof that the former spouse is eligible for Coverage under the spouse equity provisions.